October 02, 2014

Epic Systems is "feeling political heat" as questions about whether its records can talk to other vendors' records continue to grow, Darius Tahir writes at Modern Healthcare.

Background on EHR requirements, interoperability

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments. And a portion of the meaningful use requirements mandates that providers are able to share EHR data with other providers, Julie Creswell writes in the New York Times.

Providers with systems that are not interoperable could eventually face Medicare penalties under the program.

Two recent studies found that fewer than 50% of hospitals in the U.S. can transmit a patient care document, while just 14% of doctors can exchange patient data with outside hospitals or other providers, according to the Times.

Insight from Crimson CEO Glenn Tobin

Data exchange barriers remain

Providers have said that certain EHR systems were built to impede the ability to share patient data, contrary to the meaningful use program's requirements. For example, writes Creswell, some providers have pinpointed Epic's EHR systems as being deliberately created so they cannot share data with competing EHR systems. (Related: AllScripts, Netsmart collaborate on interoperability.)

Raghuvir Gelot, a physician at a North Carolina-based practice that has struggled to share patient data on its Epic system with outside providers, says, "The systems can't communicate, and that becomes my problem because I cannot send what is required and I'm going to have a 1% penalty from Medicare." He also notes that the federal government is "asking [him] to do something [he] can't control."

In addition, providers have noted that when systems can share data, they often require significant upfront charges to connect or recurring fees. The charges can inhibit smaller practices from connecting with larger, more technologically savvy and financially sound health systems, notes Creswell.

"We've spent half a million dollars on an electronic health record system about three years ago, and I'm faxing all day long. I can’t send anything electronically over it," said Dr. William L. Rich III, a member of a nine-person ophthalmology practice in Northern Virginia and medical director of health policy for the American Academy of Ophthalmology.

"We've spent half a million dollars on an electronic health record system about three years ago, and I'm faxing all day long. I can’t send anything electronically over it." — Dr. William L. Rich III

According to the Times, regulators so far have failed to respond to the interoperability issue. A spokesperson for the Office of the National Coordinator for Health IT in an emailed statement says that stakeholders must "come together and agree on policy-related issues like who can access information and for what purpose." The spokesperson adds that interoperability is a "top priority" and noted the office recently released a 10-year vision and agenda on the issue.

Lawmakers now looking into issue

The mounting questions over health records' interoperability has led to Epic facing considerable scrutiny on Capitol Hill, Tahir writes at Modern Healthcare.

At a House meeting in July, Rep. Phil Gingrey (R-Ga.) singled out Epic's EHR for criticism, saying that the company created "closed records"—a problem, given the federal government's incentives for providers to purchase electronic records.

"Is the government getting its money's worth?" Gingrey asked. "It may be time for the committee to take a closer look at the practices of vendor companies in this space, given the possibility that fraud may be perpetrated on the American taxpayer."

The Advisory Board on interoperability

Interoperability is high on the list of top priorities for health care executives—and only going higher.

Thirty percent of health care spending is wasted on costly, redundant, and ineffective care because today's systems cannot provide a complete view of the individual. Often by definition, today's patients are being cared for in different places. They switch hospitals, payors, health systems, and doctors, but their data cannot readily follow them across care settings.